Critical evaluation of stents in coronary angioplasty: a systematic review

Abstract

Background Coronary stents are routinely placed in the treatment and prophylaxis of coronary artery disease (CAD). Current coronary stent designs are prone to developing blockages: in-stent thrombosis (IST) and in-stent re-stenosis (ISR). This is a systematic review of the design of current coronary stent models, their structural properties and their modes of application, with a focus on their associated risks of IST and ISR. The primary aim of this review is to identify the best stent design features for reducing the risk of IST and ISR. To review the three major types of stents used in clinical settings today, determining best and relevant clinical practice by exploring which types and features of offer improved patient outcomes regarding coronary angioplasty. This information can potentially be used to increase the success rate of coronary angioplasty and stent technology in the future taking into account costs and benefits. Methods Scientific databases were searched to find studies concerning stents. After the exclusion criteria were applied, 19 of the 3192 searched literature were included in this review. Studies investigating three major types of stent design were found: bare-metal stents (BMS), drug-eluting stents (DES) and bioresorbable stents (BRS). The number of participants varied between 14 and 1264. On average 77.4% were male, with a mean age of 64 years. Results From the findings of these studies, it is clear that DES are superior in reducing the risk of ISR when compared to BMS. Conflicting results do not clarify whether BRS are superior to DES at reducing IST occurrence, although studies into newer BRS technologies show reducing events of IST to 0, creating a promising future for BRS showing them to be non-inferior. Thinner stents were shown to reduce IST rates, due to better re-endothelialisation. Scaffold material has also been shown to play a role with cobalt alloy stents reducing the risk of IST. This study found that thinner stents that release drugs were better at preventing re-blockages. Some dissolvable stents might be better at stopping blood clots blocking the arteries when compared to metal stents. The method and procedure of implanting the stent during coronary angioplasty influences success rate of these stents, meaning stent design is not the only significant factor to consider. Conclusions Positive developments in coronary angioplasty could be made by designing new stents that encompass all the most desirable properties of existing stent technology. Further work is needed to investigate the benefits of BRS in reducing the risk of IST compared to DES, as well as to investigate the effects of different scaffold materials on IST and ISR outcomes.

Biodegradable polymer everolimus-eluting stents versus contemporary drug-eluting stents: a systematic review and meta‑analysis

“…These obvious discrepancies may be partly due to the design difference of BP-DES platform 6 . Many factors, such as metal alloys, stent strut thickness, polymer composition, and distribution, may affect the time course of biodegradable polymer and scope of endothelial stent coverage, as well as the function and maturation of endothelial cells 7 , 57 . These aspects emphasize that device specific analysis is more important than stent category.…”

Revascularization strategies for patients with established chronic coronary syndrome

“…Notwithstanding the lower incidence of in‐stent restenosis, the risk of acute and subacute stent thrombosis was corresponding in second‐generation drug‐eluting stent compared with bare‐metal stent, 50,51 indicating the administration of dual antiplatelet therapy. Nevertheless, the current risk of stent thrombosis with newer drug‐eluting stent is low 52 …”

Health-related Quality of life and its related factors in patients undergoing Coronary angioplasty, Zanjan, northwest Iran

“…Different medications and surgeries have been used to treat heart disease. Coronary angioplasty is also used as a routine intervention in the treatment of this disease (4). The percutaneous coronary intervention (PCI) performed in the angioplasty method leads to an acceptable improvement of the patient's symptoms (5).…”

“…Angioplasty as a beneficial intervention can significantly improve the patient's physical limitations and perception, so it is expected that the quality of life related to health will also improve (4). Harson 2021 have been shown to improve physical function and vitality after angioplasty (8).…”

“…Despite many studies on health-related quality of life in heart patients (4,10,16,17), a study to evaluate the health-related quality of life in patients who have undergone angioplasty are limited (18). literature review showed various factors have been introduced as factors affecting the quality of life of angioplasty patients, including breathlessness, angina grade, exercise time,age, the number of diseased vessels, the number of comorbidities, diabetes, a history of cardiovascular disease and symptoms of shortness of breath (16)(17)(18)(19)(20)(21)(22)(23).…”